Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease: A Meta-analysis

The following is a synopsis of “Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease: A Meta-analysis,” which was published in March 2016 in Journal of the American Medical Association Internal Medicine.

What is already known on this issue? What is added by this article? Improving medication adherence may be the intervention The authors of this article sought to estimate the effect of text with the greatest potential for improving the health of a messaging on medication adherence in adults with chronic population. Poor medication adherence is linked to increased disease. Their secondary objective was to look at frequency of hospitalizations, medical interventions, morbidity, mortality, messaging, interactivity, and customization, and to describe and costs, yet current strategies for improving adherence perceptions and acceptability to participants. to medication therapies used to treat chronic diseases are complex and largely ineffective. The authors conducted a literature search of MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register Text messages have been used to communicate health or Controlled Trials, and trial registries; their article is in information to patients, but the evidence supporting this accordance to the Preferred Reporting Items for Systematic approach is limited to narrative reviews, not meta-analyses. Reviews and Meta-analyses statement and the Cochrane Mobile apps, pagers, and dedicated devices for audiovisual Collaboration reporting items for systematic reviews and reminders have also been used to communicate health meta-analysis. The inclusion criteria were: randomized information to patients, but are not as available as text clinical trials with at least four weeks’ follow-up, involving messaging. Text messaging is available on any existing mobile adult patients with chronic disease who received a mobile device and is used by all socioeconomic groups and ages, telephone text message intended to improve medication and on all continents. In fact, in 2014, the number of mobile adherence, and including a description of the quantitative subscribers was approximately 7 billion, essentially equal to effect of the messaging. the global population. Therefore, the use of text messages sent to a patient’s mobile telephone may be an effective way The exclusion criteria were: studies that included interventions to improve adherence. beyond text messaging; did not report a quantitative measure of medication adherence; and/or involved psychiatric, military, or institutionalized patients. Two reviewers independently intervention and expressed a desire to continue receiving screened all identified titles and abstracts using a predefined messages. A small number of patients reported that twice a day protocol, assessed the risk of bias in accord with the Cochrane and early morning (7:00 a.m. and 10:00 a.m.) messaging were Handbook for Systematic Reviews of Interventions, and used disruptive to daily routines. software called Comprehensive Meta-analysis (version 2.2.06) for statistical analysis. What are the implications of these findings? Forty-four articles were assessed and 16 randomized clinical Text message based interventions have the potential for trials involving 2,742 patients were identified. The median improving medication adherence. sample size was 97, the median age of the participants was 39 years, and 50.3% were female. Several chronic diseases were A combination of strategies that can increase medication represented in the studies discussed and the median duration adherence to anti-hypertensive medications is usually of intervention was 12 weeks. The most common methods necessary, but the implementation of multiple strategies is used to assess adherence were self-recall, medication event complex, resource intensive, and unrealistic in clinical practice. monitoring system, and pill count. The adherence cut-off ranged Text message-based interventions offer a simple, easy, and from 80% to 95% for each trial. Although the message content automated approach to improving medication adherence. was primarily medication reminders, the characteristics of text Mobile phone text messaging approximately doubles the odds messages varied considerably among studies and included both of medication adherence. This increase translates into adherence medical and non-medical information. The frequency of text rates improving from 50% (assuming this baseline rate in messages also varied from daily to weekly; in some, customized patients with chronic disease) to 67.8%, or an absolute increase patterns were used. The majority of studies used automated of 17.8%. messaging, and a few timed the message with the medication administration time. High quality studies in appropriate patient populations aiming to identify which features are most effective are now necessary, The authors concluded that text message based interventions even as researchers must continue to look at sustained effects significantly improved medication adherence in patients with and influences on clinical outcomes. These results should be chronic disease, even after taking into consideration publication interpreted with caution given the short duration of trials and bias. They did not find significant effects of text messages on reliance on self-reported medication adherence measures. adherence when the frequency of messaging was increased and Unanswered questions remain. Is fixed message content or 2-way communications were employed. However, a moderate customized content more effective? Is fixed-frequency or real- effect was observed when messages were personalized and time medication monitoring better? What about fixed message included the participant’s name. There was no significant content vs. customized content, and standard vs. personalized difference in adherence when the frequency of messaging messages? Finally, which has the greater effect on adherence: varied from daily to less than daily. In 11 studies participant 1-way or 2-way communication? feedback was reported and most participants reported moderate to high levels of satisfaction with the text message

Resources Calculating Proportion of Days Covered (PDC) for Antihypertensive and Antidiabetic Medications: Million Hearts An Evaluation Guide for Grantees Improving Medication Adherence Among Patients with Hypertension: http://www.cdc.gov/pending A Tip Sheet for Health Care Professionals http://millionhearts.hhs.gov/files/TipSheet_HCP_MedAdherence.pdf Citation

Centers for Disease Control and Prevention Thakkar J, Kurup R, Laba, T, et al. Mobile Telephone Text Messaging Partnering with Pharmacists in the Prevention and Control of for Medication Adherence in Chronic Disease: A Meta-analysis. Chronic Disease JAMA Internal Medicine. 2016:176(3):340-349. dol:10.1001/ http://www.cdc.gov/dhdsp/programs/spha/docs/pharmacist_guide.pdf jamainternmed.2015.7667

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Chronic Disease Prevention and Health Promotion Division of Heart Disease and Stroke Prevention

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